2024-05-10T14:47:52-05:00 2023-06-30 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2022-07-01 821820277 Jefferson Regional Medical Center Foundation % JEREMY JEFFERY JEFF 8705417100 1600 West 40th Avenue Pine Bluff AR 71603 Jeremy Jeffery TREASURER 8705417100 2023-11-15 true Jeremy Jeffery 999009999 Jeanette Verrelli P00742631 9727028262 2 2022 2023-04-26 12:10:37Z DEBE HOLLINGSWORTH 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 420444 false X N/A X 2017 AR TO MAKE DISTRIBUTIONS OF PROPERTY FROM THE FOUNDATION TO ORGANIZATIONS THAT THEN QUALIFY AS EXEMPT ORGANIZATIONS 13 11 1 22 0 0 1206775 362745 0 0 9559 7383 -4973 20443 1211361 390571 1215000 562436 0 0 70992 79695 0 0 0 72865 56573 1358857 698704 -147496 -308133 1028725 574163 120433 34917 908292 539246 THE FOUNDATION RAISES FUNDS THAT DIRECTLY SUPPORT JEFFERSON REGIONAL MEDICAL CENTER AND THE COMMUNITIES WE SERVE. TOGETHER WE ARE BRINGING THE HIGHEST QUALITY HEALTHCARE TO SOUTHEAST ARKANSAS. false false 562436 562436 The Foundation hosted its annual golf tournament. The proceeds benefit projects and services at Jefferson Regional. Also, the Pink Luncheon and Pink Out 5K both benefit the Jefferson Regional Breast Center. Additionally, the Foundation authorized grants to Jefferson Regional for nursing scholarships, patient assistance and cancer center patients. 562436 true true false false false false false false false false false false false false true false false true false false false false false false true false false true true true false false false false false false false false false false false false false true true false false false true X 0 0 1 true false false false false false true true false false false false false false X 13 11 false false false false true true false true true false false true true true true true true false false false AR X JEREMY JEFFERY 8705417100 1600 WEST 40TH AVENUE PINE BLUFF AR 71603 X J BRIDGFORTH - SEE SCH O CHAIR 1.0 0.0 X X 0 0 0 G DUNKLIN - SEE SCH O Member 0.25 0.0 X 0 0 0 L KOSMITIS - SEE SCH O Member 0.25 0.0 X 0 0 0 G CASTEEL - SEE SCH O Member 0.25 0.0 X 0 0 0 C BLAKELY - SEE SCH O Member 0.25 0.0 X 0 0 0 B JONES - SEE SCH O Member 0.25 0.0 X 0 0 0 C TROTTER - SEE SCH O Member 0.25 0.0 X 0 0 0 M BELLINGRATH - SEE SCH O Member - term expired: 1/23 0.25 0.0 X 0 0 0 N MAKRIS - SEE SCH O Member - term expired: 1/23 0.25 0.0 X 0 0 0 N OUDIN - SEE SCH O Member 0.25 0.0 X 0 0 0 F PETETT - SEE SCH O Member - term expired: 1/23 0.25 0.0 X 0 0 0 B THOMAS - SEE SCH O PRESIDENT, ex-officio 1.0 40.0 X X 0 0 0 B JACKSON - SEE SCH O TREASURER, ex-officio 1.0 40.0 X X 0 0 0 D HOLLINGSWORTH - SEE SCH O Ex officio 1.0 0.0 X X 0 0 0 L RANDLE - SEE SCH O Member - term start: 1/23 0.25 0.0 X 0 0 0 A SANDERS - SEE SCH O Member 0.25 1.0 X 0 0 0 0 0 0 0 false true false 0 41353 321392 362745 0 7383 7383 0 0 0 0 0 0 50251 41353 29873 20378 20378 0 0 0 0 0 0 MISCELLANEOUS REVENUE 900099 65 65 65 390571 27826 550936 550936 11500 11500 0 0 0 0 68105 68105 0 11590 11590 0 0 725 725 5517 5517 0 0 0 16323 16323 0 4775 4775 0 0 2244 2244 450 450 0 0 0 0 0 0 BANK CHARGES 4532 4532 DUES/FEES 603 603 . 0 . 0 21404 21404 698704 562436 136268 0 334550 139772 0 0 392446 186192 0 0 0 0 0 0 0 0 0 0 4250 4250 0 0 297479 243949 0 0 0 0 0 0 0 0 1028725 574163 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 120433 34917 120433 34917 X -44082 166400 952374 372846 908292 539246 1028725 574163 -308133 -60913 X false true X true false X X X 1 JEFFERSON HOSPITAL ASSOCIATION 710329353 3 true 548436 0 1 548436 0 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO AFFILIATE 34917 34917 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. GOLF EVENT 72595 34265 38330 2200 2794 8186 1095 1583 Pretty in pink 10792 2158 8634 6310 1205 1 8217 4930 3287 4714 1786 91604 41353 50251 2200 7508 14496 1095 4574 29873 20378 true JEFFERSON HOSPITAL ASSOCIATION 1600 W 40TH AVE PINE BLUFF AR 71603 710329353 501(C)(3) 548436 CANCER CENTER OPERATIONS & CAPITAL COSTS 1 NURSING SCHOLARSHIPS 27 11500 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION MAINTAINED RECORDS TO SUBSTANTIATE THE AMOUNT OF THE GRANTS OR ASSISTANCE, THE GRANTEES' ELIGIBILITY FOR THE GRANTS OR ASSISTANCE, AND THE SELECTION CRITERIA USED TO AWARD GRANTS OR ASSISTANCE. false true false false false false false false false SCHEDULE J, PART I, LINE 3 METHOD TO DETERMINE EXECUTIVE COMPENSATION: THE TOP MANAGEMENT OFFICIAL IS A VOLUNTEER AND NOT COMPENSATED BY THE FOUNDATION OR ANY RELATED ORGANIZATION. SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP PLAN REPORTED IN W-2 DEFERRED COMPENSATION --------------------------- ----------------- ---------------------- Bryan JacksON $86,329 NONE BRIAN THOMAS $281,721 NONE Schedule J, Part II COMPENSATION TABLE: COMPENSATION INFORMATION REQUIRED IN FORM 990, PART VII, SECTION A AND SCHEDULE J, PART II IS PROVIDED IN A TABLE ATTACHED TO THE TAX RETURN DOCUMENT FOLLOWING SCHEDULE R. THE AMOUNTS ARE INCLUDED IN THE ATTACHMENT. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS: THE SOLE MEMBER IS JEFFERSON HOSPITAL ASSOCIATION, INC. FORM 990, PART VI, SECTION A, LINE 7A APPOINT MEMBERS OF THE GOVERNING BODY: THE SOLE MEMBER WILL ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990: THE BOARD HAS DELEGATED THE REVIEW OF THE 990 TO AN AD HOC COMMITTEE MADE UP OF THE PRESIDENT, TREASURER, AND EXECUTIVE DIRECTOR OF THE FOUNDATION. THE FINAL 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS TO MONITOR COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS. THE BOARD ANNUALLY REVIEWS POTENTIAL CONFLICTS IN ACCORDANCE WITH ITS POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW: THE TOP MANAGEMENT OFFICIAL IS A VOLUNTEER AND NOT COMPENSATED BY THE FOUNDATION OR ANY RELATED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A & SCHEDULE J, PART II COMPENSATION TABLE: COMPENSATION INFORMATION REQUIRED IN FORM 990, PART VII, SECTION A AND SCHEDULE J, PART II IS PROVIDED IN A TABLE ATTACHED TO THE TAX RETURN DOCUMENT FOLLOWING SCHEDULE R. THE AMOUNTS ARE INCLUDED IN THE ATTACHMENT. FORM 990, PART V, LINE 2A EMPLOYEES REPORTED ON FORM W-3: JEFFERSON HOSPITAL ASSOCIATION, INC IS THE COMMON PAY MASTER FOR THE FOUNDATION. ALL W-2S ARE FILED BY THE HOSPITAL WITH PAYROLL EXPENSE ALLOCATIONS REPORTED ON THE FOUNDATION. JEFFERSON HOSPITAL ASSOCIATION 1600 WEST 40TH AVE PINE BLUFF AR 71603 710329353 HOSPITAL AR 501(C)(3) 3 NA false JEFFERSON MANAGEMENT SERVICES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710582753 PHY PRACTICE AR JHA C-CORPORATION true JHA HEALTH AFFILIATES INC 1600 W 40TH AVE PINE BLUFF AR 71603 710766959 REAL EST RENT AR JHA C-CORPORATION true false true false false true false false false false false false false false false false false false false false